A simple cognitive reframing strategy reduces sensory brain responses in autistic youth

Mentally reframing an unpleasant physical sensation by describing it like an objective news reporter can quiet activity in sensory areas of the brain in autistic children and teens, according to new research published in the Journal of Child Psychology and Psychiatry. Although a brief session of this mental strategy did not immediately change how unpleasant the autistic participants said the textures felt, brain scans indicated that it reduced neural activity in regions that process touch and sound.

Many people with neurodevelopmental or psychiatric conditions, including attention-deficit/hyperactivity disorder (ADHD) and anxiety, experience sensory over-responsivity. This condition involves intense, distressing reactions to everyday sensory inputs that most people easily ignore, such as scratchy clothing tags or background hums. Sensory over-responsivity is especially common in autism, where it often interferes with daily routines, social interactions, and emotional well-being, yet few evidence-based treatments exist to ease this distress.

Part of the challenge in treating sensory sensitivity lies in how the autistic nervous system registers and evaluates physical sensations. For instance, a study of touch responses in autistic adults found that while autistic participants showed weaker automatic skin-sweat responses to touch than non-autistic peers, they reported stronger subjective feelings for both pleasant and unpleasant textures. To see how the brain responds to unpleasant sensations in youth, scientists use functional magnetic resonance imaging (fMRI), a technique that tracks neural activity by measuring changes in blood flow. Findings from a 2015 brain-imaging study by Shulamite A. Green and colleagues indicated that when autistic children encounter scratchy textures or irritating sounds, they display heightened activity in primary sensory areas and in the amygdala, an almond-shaped structure deep in the brain that processes threats and emotions.

In people without sensory sensitivities, the brain normally gets used to repeated harmless sensations through a process called habituation, which the prefrontal cortex, the frontmost part of the brain responsible for planning and self-control, is thought to help maintain. However, a 2019 neuroimaging study by Green and colleagues showed that autistic youth with severe sensory over-responsivity have weaker communication between the prefrontal cortex and the amygdala, a pattern linked to difficulty sustaining habituation during unpleasant stimulation. Evidence from a 2023 cross-sectional study by Green’s team also indicated that these frontal regulatory circuits mature later in adolescence for autistic youth than for typically developing peers.

Because sensory over-responsivity has been linked to weaker top-down brain regulation, meaning control from higher-level brain regions, the authors of the new study examined whether actively engaging the prefrontal cortex could dial down sensory hyperactivity. They focused on cognitive reappraisal, a mental strategy commonly taught in talk therapy where a person deliberately changes how they think about an upsetting stimulus to alter their emotional response to it. The new research was led by first author Urvi T. Shah of the University of Washington alongside senior author Green, an associate professor, Friends of the Semel Institute Term Chair, and director of the Sensory Cognitive and Affective Neurodevelopment (SCAN) Lab at the Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles.

Free daily newsletter

“There are almost no evidence-based interventions for sensory over-responsivity even though it makes life very difficult, especially for autistic individuals,” Green told PsyPost. “Much of my work to date has focused on identifying the underlying biological mechanisms of sensory over-responsivity in order to inform treatment.”

“We have found that autistic kids with sensory over-responsivity tend to activate fewer prefrontal regulatory regions of the brain when they experience aversive sensory stimulation in an MRI brain scanner,” she explained. “We thought this might mean they’re having difficulty regulating their responses to sensory information. Our reappraisal study was designed to determine if we could teach autistic kids to engage prefrontal cortex and reduce their sensory reactivity.”

The researchers analyzed data from 47 autistic youth and 45 typically developing youth aged 8 to 15, with an average age of 13. The groups were matched on age and IQ (both averaging a Full-Scale IQ of 110 on the Wechsler Abbreviated Scales of Intelligence) and did not differ significantly in sex, ethnicity, or race. Of the 80 autistic and 54 typically developing youth originally recruited, 31 and 9, respectively, were excluded for head movement in the scanner, along with a small number of other exclusions. All included participants passed a practice scan confirming they could lie still, follow instructions, and respond verbally.

Parents completed the Sensory Experiences Questionnaire to measure how strongly their children reacted to everyday sensory inputs. Autistic participants had higher average sensory over-responsivity scores (77.98) than typically developing participants (40.95). Parents also filled out the Screen for Child Anxiety-Related Emotional Disorders, where autistic youth averaged a score of 26.02 compared to 7.33 in the typically developing group, which the researchers accounted for when examining how sensory symptom severity related to brain activity.

Before entering the MRI scanner, each participant completed a short training session on how to use cognitive reappraisal. Inside the scanner, they wore noise-canceling headphones and earplugs while an experimenter rubbed their inner left forearm with two mildly unpleasant materials: artificial grass and scratchy wool fabric. Across nearly eight minutes, participants experienced twelve 20-second blocks of touch separated by 13.5-second rest periods.

Before each 20-second block, a two-second visual and audio prompt instructed the child on how to approach the sensation. During the six “React” trials, participants saw the word “feel” and experienced the texture naturally. During the six “Reappraise” trials, they saw the word “reporter” and mentally described the texture objectively, as if they were a news reporter, to distance themselves emotionally from the discomfort.

After each block, participants had four seconds to answer “How badly do you feel?” using a handheld button box on a scale from 1 (least bad) to 4 (most bad). One typically developing participant missed more than half of the rating prompts, leaving 47 autistic and 44 typically developing youth in the behavioral analysis.

Across both groups, participants rated the artificial grass as more unpleasant than the wool sweater fabric, giving the grass an average distress score of 2.34 out of 4 compared to 1.44 for the wool. Only the typically developing group reported lower discomfort during reappraisal, and only for the grass texture, where their average rating showed a small drop of about 0.15 points, from 2.38 during React to 2.23 during Reappraise. In the autistic group, self-reported distress ratings did not show a statistically significant difference between the two conditions.

Even without a shift in their button ratings, the brain scans indicated that autistic youth altered how they processed touch during reappraisal. When reacting naturally, the only whole-brain difference between the two groups was higher activity among autistic youth in the cerebellum, a structure at the base of the brain involved in coordination and sensory prediction. When participants acted like an objective reporter during reappraisal, the two groups no longer differed significantly in whole-brain activity.

Comparing the two conditions directly showed that reappraisal reduced activity in the autistic group’s somatosensory cortex, a strip of tissue along the top and sides of the brain that registers touch, and the insula, a deep cortical fold that integrates sensory and bodily signals. By contrast, typically developing youth showed no brain regions with reduced activity during reappraisal, and their somatosensory cortex activity actually edged up slightly when switching from React to Reappraise. The authors suggest that typically developing youth did not need to dial down their primary sensory regions because their baseline sensory responses were lower to begin with.

Targeted analyses also uncovered a change in the primary auditory cortex, the brain region that processes sound. Even though the task only involved touch on the arm, autistic youth showed reduced auditory cortex activity during Reappraise compared to React, whereas typically developing youth did not. The authors suggest that adopting an objective mindset may have helped autistic youth filter out the loud mechanical noise of the MRI scanner itself.

The researchers next looked at frontal brain regions involved in self-regulation, starting with the dorsomedial prefrontal cortex toward the upper-middle front of the brain. Typically developing youth showed increased activity in the dorsomedial prefrontal cortex and language-processing areas during reappraisal, whereas the autistic group as a whole did not show a statistically significant increase in frontal regions on its own. Across all participants combined, an increase in dorsomedial prefrontal cortex activity during reappraisal fell just short of statistical significance, and the two groups did not differ significantly from each other in this region.

A second regulatory region, the orbitofrontal cortex located just above the eye sockets, was active across both groups, particularly on the left side. The authors note that this left-sided pattern could reflect either the left hemisphere’s role in putting experiences into words or the fact that the textures were rubbed on the left arm. In the right orbitofrontal cortex, however, autistic youth showed a steeper drop in activity during reappraisal than typically developing peers, which the authors suggest may reflect an efficient suppression of the right side to prioritize left-sided regulation.

Within the autistic group, brain responses varied with the severity of a child’s everyday sensory symptoms, even after accounting for anxiety. Autistic youth with milder sensory over-responsivity showed larger reductions in sensory cortex activity during reappraisal, whereas those with more severe symptoms showed smaller reductions in sensory regions alongside greater increases in frontal control areas. The authors suggest that youth who are most sensitive to sensory input may have to exert greater mental effort to reappraise without an immediate reduction in sensory cortex activity, and may need more practice to use the strategy efficiently, though it is also possible that reappraisal simply works better for children with milder symptoms.

Age was not linked to the size of the reductions in sensory cortex activity among autistic youth, suggesting that reappraisal may quiet sensory regions across the ages studied. However, age did relate to other brain patterns: younger autistic children showed more activity in visual areas at the back of the brain during React, an age-related pattern that did not appear during reappraisal. Meanwhile, older autistic teens showed greater activation during reappraisal in lower frontal regions, specifically the frontal pole and orbitofrontal cortex. Because prior research shows that typically developing youth shift from using lower to upper frontal circuits as they move into adolescence, the authors note that this pattern in older autistic teens may point to a delayed maturation of the frontal regions that support sensory regulation.

“Teaching autistic kids to use a common emotion regulation technique seems to help reduce their brain’s sensory responses to aversive sensory stimulation,” Green said. “This suggests that when they think about sensory stimuli more objectively, such as focusing on the ‘facts’ of the sensory stimulus, their brain may not respond as strongly in regions that usually process basic sensory information. In particular, older teens with autism may engage more of the prefrontal brain regions that help with emotional and behavioral regulation. This type of emotion regulation strategy could be incorporated into interventions and tested to see if it helps with sensory over-responsivity in everyday life.”

“I was surprised that while on the whole, the group of autistic kids all reduced reactivity in sensory brain regions when using reappraisal, only the older autistic kids engaged prefrontal regulatory regions,” Green noted. “This is in contrast to the typically developing controls who, as a group, engaged prefrontal cortex, regardless of age. This is consistent with some of our prior research that autistic teens may take longer to develop sensory regulation compared to typically developing teens. However, our results suggest that reappraisal can be helpful in reducing sensory responses even for younger autistic youth who don’t engage regulatory regions as much.”

The unchanged distress ratings in the autistic group echo a study of daily stress in autistic youth, which found that adaptive emotion regulation strategies did not buffer everyday stress and negative emotions in autistic adolescents and young adults. While that earlier work relied on daily self-reports rather than an experimental sensory task in an MRI scanner, both studies suggest that cognitive regulation strategies may be less effective at immediately easing subjective distress in autistic youth than in non-autistic peers.

At the neural level, the results also complement a brain-imaging study of children with sensory over-responsivity, which linked heightened sensory sensitivity to weaker connectivity within outward-facing sensory networks and stronger connectivity within inward-facing control networks at rest. Although the new study measured brain activity during an active reframing task in autistic youth rather than resting connectivity in non-autistic neurodiverse children, the new findings similarly suggest that how the brain regulates sensory input differs in youth with sensory over-responsivity.

There are a few things to keep in mind when interpreting these findings. Participants only received a brief training session before the scan, and clinical therapies typically require weeks of practice before a person notices changes in how they consciously feel. Autistic individuals also frequently experience differences in interoception, the ability to sense internal bodily signals, as well as challenges with rapidly switching between mental tasks, which the task’s 20-second alternation required. Both factors may have made it harder for participants to register subtle shifts in their moment-to-moment discomfort.

Because many initially recruited autistic youth were excluded due to scanner movement, and the included participants had IQ scores ranging from borderline to well above average (75 to 146) and had to be able to respond verbally to instructions, the results may not generalize to autistic youth with intellectual disabilities or limited spoken language. Future studies will need to test cognitive reappraisal outside the demanding MRI environment and evaluate whether multi-week training in cognitive behavioral therapy can produce lasting relief in daily life.

“This reappraisal task was difficult for younger kids or those with more cognitive challenges, so while it is promising as an intervention, it may be most useful for autistic individuals with cognitive and verbal skills in the average range or higher,” Green added.

The study, “Cognitive reappraisal modulates neural responses to aversive sensory stimulation in autistic youth,” was authored by Urvi T. Shah, Karrin Evans, Megan Banchik, Apurva Chaturvedi, Sapna Ramappa, Katie Wong, Jennifer A. Silvers, and Shulamite A. Green.